Bariatric Surgery Candidates Research Articles

Predictive Factors for Obstructive Sleep Apnea Diagnosis in Bariatric Surgery Candidates with or Without Chronic Insomnia Complaints.

This study aims to evaluate the frequency of insomnia complaints in bariatric patients and to assess obstructive sleep apnea (OSA) predictors according to the presence or absence of chronic insomnia. Insomnia was defined as the presence of at least one specific symptom: difficulty falling asleep, difficulty maintaining sleep, and/or waking up earlier than expected. Diagnosis of OSA was objectively obtained from in-laboratory polysomnography. Multivariate logistic regression analysis was used to assess OSA predictors. This cross-sectional study contains 1,737 bariatric surgery candidates: 59.6% without insomnia and 40.4% with insomnia. OSA prevalence was similar among participants with or without insomnia either for any OSA (p = 0.168) or for moderate-to-severe OSA (p = 0.185). Patients without insomnia showed a higher prevalence of severe OSA than those with insomnia (p = 0.005). In both cohorts, five parameters were independent OSA predictors: sex, age, body mass index (BMI), neck circumference (NC), and excessive daytime sleepiness (EDS). Male sex was the most important predictor, whether in individuals without insomnia (adjusted odds ratio [OR] ranging from 4.874 to 8.369) or in those with insomnia (adjusted OR ranging from 5.672 to 12.441). A considerable proportion of bariatric patients report insomnia complaints. The probability of suffering from OSA was similar among bariatric candidates with or without insomnia, except for severe OSA diagnosis. Sex, age, BMI, NC, and EDS were independent predictors for OSA diagnosis irrespective of insomnia symptoms, and male sex was the main predictor for OSA in bariatric individuals with or without insomnia.

Eating Disorder Symptomatology Among Adolescents Presenting for Bariatric Surgery Candidacy: Examining Differences by Sex and Racial Minority Status.

Research on adolescent bariatric surgery candidates is limited by insufficient inclusion of ethnic minorities and males, and lack of consideration of the full spectrum of disordered eating behaviors (i.e., restriction, compensatory behaviors [e.g., purging], overeating/binge eating behaviors). The current study investigated differences in the full range of disordered eating behaviors across sex and ethnicity among adolescents seeking bariatric surgery. Teaching hospital, United States. Data were collected using retrospective chart review of 79 adolescent bariatric surgery candidates (59% female, 46.8% Hispanic, MBMI = 50.2, SDBMI = 10.0, Mage = 17.3, SDage = 2.02) who had completed the self-reported Eating Disorder Diagnostic Scale for DSM-5 at intake. Approximately 33% of study participants met self-reported criteria for an eating disorder, with 35% endorsing binge eating behaviors and 50% endorsing compensatory behaviors. Few differences in behavior frequencies were observed across sex or racial/ethnic status. Findings underscore the importance of assessing the full spectrum of disordered eating behaviors among adolescent bariatric surgery candidates.

S1174 Does Bariatric Surgery Decrease Risk of Cirrhosis and HCC?

Introduction: Most patients with known Nonalcoholic Fatty Liver Disease (NAFLD) have metabolic syndrome. After undergoing weight loss surgery, many patients with NAFLD have rapid weight loss and subsequent correction of their metabolic syndrome leading to improvement in their liver disease. However, there is minimal data evaluating weight loss surgery in obese patients and the development of cirrhosis and HCC. Our aim is to determine whether there is a correlation between bariatric surgery and the development of cirrhosis and HCC in an obese population. Methods: We performed a retrospective analysis in the IBM Explorys database 5 (1999-2021), a pooled, national, de-identified clinical database of over 72 million unique patients from 26 health care networks and 300 hospitals across the United States. Patient populations were identified using SNOMED and ICD codes. Obese patients (BMI greater than 30) who had bariatric surgery, including Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, and Gastric Banding were identified. Patient data was evaluated to determine the number of patients who had developed cirrhosis or HCC, after at least 3 months of surgery. Additionally, patient data was analyzed for complications of cirrhosis, including development of ascites, esophageal varices, and hepatic encephalopathy. Odds ratio with 95% CI were calculated to assess risk of cirrhosis, cirrhosis complications, and HCC compared to a control cohort. Results: Weight loss surgery was associated with a decreased likelihood of developing HCC (OR 0.37, CI 0.24-0.58) and cirrhosis (OR 0.65, CI 0.60-0.70). However, there was an increased risk of having cirrhosis complications in patients with cirrhosis after having weight loss surgery. Increased cirrhosis complications included ascites (OR 26.30, CI 21.33–32.42), esophageal varices (OR 30.26, CI 24.55-37.31), and hepatic encephalopathy (OR 22.53, CI 16.91-30.01). Conclusion: Our data supports that weight loss is beneficial in NAFLD patients. Patients with obesity, who are unable to lose weight through lifestyle modifications, should be considered as candidates for bariatric surgery. We found that weight loss surgery was associated with reduced risk of developing cirrhosis and HCC. However, we found that once patients have developed cirrhosis, weight loss surgery may increase the risk of complications including ascites, esophageal varices, and hepatic encephalopathy. Future prospective studies are needed to validate these studies.Table 1

Prospective comparison of transient elastography, MRI and serum scores for grading steatosis and detecting non-alcoholic steatohepatitis in bariatric surgery candidates

Background & AimsTools for the non-invasive diagnosis of non-alcoholic steatohepatitis (NASH) in morbidly obese patients with suspected non-alcoholic fatty liver disease (NAFLD) are an unmet clinical need. We prospectively compared the performance of transient elastography, MRI, and 3 serum scores for the diagnosis of NAFLD, grading of steatosis and detection of NASH in bariatric surgery candidates.MethodsOf 186 patients screened, 152 underwent liver biopsy, which was used as a reference for NAFLD (steatosis [S]>5%), steatosis grading and NASH diagnosis. Biopsies were read by a single expert pathologist. MRI-based proton density fat fraction (MRI-PDFF) was measured in an open-bore, vertical field 1.0T scanner and controlled attenuation parameter (CAP) was measured by transient elastography, using the XL probe. Serum scores (SteatoTest, hepatic steatosis index and fatty liver index) were also calculated.ResultsThe applicability of MRI was better than that of FibroScan (98% vs. 79%; p <0.0001). CAP had AUROCs of 0.83, 0.79, 0.73 and 0.69 for S>5%, S>33%, S>66% and NASH, respectively. Transient elastography had an AUROC of 0.80 for significant fibrosis (F0-F1 vs. F2-F3). MRI-PDFF had AUROCs of 0.97, 0.95, 0.92 and 0.84 for S>5%, S>33%, S>66% and NASH, respectively. When compared head-to-head in the 97 patients with all valid tests available, MRI-PDFF outperformed CAP for grading steatosis (S>33%, AUROC 0.97 vs. 0.78; p <0.0003 and S>66%, AUROC 0.93 vs. 0.75; p = 0.0015) and diagnosing NASH (AUROC 0.82 vs. 0.68; p = 0.0056). When compared in “intention to diagnose” analysis, MRI-PDFF outperformed CAP, hepatic steatosis index and fatty liver index for grading steatosis (S>5%, S>33% and S>66%).ConclusionMRI-PDFF outperforms CAP for diagnosing NAFLD, grading steatosis and excluding NASH in morbidly obese patients undergoing bariatric surgery.Lay summaryNon-invasive tests for detecting fatty liver and steatohepatitis, the active form of the disease, have not been well studied in obese patients who are candidates for bariatric surgery. The most popular tests for this purpose are Fibroscan, which can be used to measure the controlled attenuation parameter (CAP), and magnetic resonance imaging, which can be used to measure the proton density fat fraction (MRI-PDFF). We found that, when taking liver biopsy as a reference, MRI-PDFF performed better than CAP for detecting and grading fatty liver as well as excluding steatohepatitis in morbidly obese patients undergoing bariatric surgery.

Gastrointestinal quality of life before and short- and long-term after Roux-en-Y gastric bypass for severe obesity.

Overall quality of life (QoL) is generally improved after bariatric surgery. Gastrointestinal (GI) symptoms including abdominal pain have been reported in up to >30% of patients after Roux-en-Y gastric bypass (RYGB), and may negatively influence QoL, especially GI-QoL. To evaluate the evolution of GI symptoms and GI-QoL short- and long-term after RYGB. Two public hospitals METHODS: Candidates for bariatric surgery (n = 128, BMI = 44.2 ± 7.4) or patients who had undergone RYGB 2-4 years (n = 161, BMI = 29.3 ± 15.9) and 5-10 years (n = 121, BMI = 31.3 ± 6.5) before were invited to complete a questionnaire combining 3 validated questionnaires (GIQLI, GSRS, and PCS) specifically designed to evaluate GI-QoL. Scores were compared between the preoperative, early, and late postoperative periods. The GIQLI score improved from 88.1 before surgery to 118.6 (P < .0001) and 109.7 (P < .0001) in the early and late postoperative periods respectively. GSRS score improved from 15.6 to 10.1 (P = .0001) and 12.8 (P = .012), and PCS-score improved from 19 to 4.5 (P = .0001) and 8.3 (P= .0001), respectively. The GI subscore of the GIQLI improved from 57.4 to 62.1 (P = .007) in the early period but was not significantly different in the late period (59.3 versus 57.4, P = .3). The psychological impact of GI symptoms decreased at both postoperative time points. GI-QoL is markedly improved after RYGB, and this improvement persists up to 10 years. GI symptoms decrease early after surgery and do not worsen in the longer term. Their psychological impact is markedly reduced.

Impact of body mass index on immunogenicity of hepatitis B vaccine in bariatric surgery candidates: A retrospective study

AimsHepatitis B virus (HBV) immunization is regarded as the most effective method for the prevention of HBV infection. Various factors, including body mass index (BMI), may contribute to decreased immunization responses. This study aimed to investigate the relationship between BMI at the time of vaccination with anti-HBs levels over the following years. MethodsIn this retrospective study, 790 vaccinated participants were recruited. Of these, individuals were selected whose hepatitis B antibody (HBsAb) information was available in 2017. The researchers contacted participants by phone to gather data regarding vaccination history, and weight at the time of vaccination. All data analysis was performed by SPSS. ResultsThis study included 165 eligible adults (28 males and 137 females). Among them, 79% participants were obese. Additionally, 46 (27.88%) and 119 (72.12%) had negative and positive HBsAb, respectively. There were no statistically significant differences seen across all characteristics, except for the number of HBV vaccinations between the positive and negative HBsAb groups. Multiple logistic regression also indicated no meaningful relationship between BMI and positive antibodies. ConclusionThere was no relationship observed between BMI and immune response to HBV vaccine in bariatric candidates. Known risk factors (age, sex, diabetes, and the number of HBV vaccinations) were not independent predictors of the antibody response to the HBV vaccine.

Evaluation of Resting Energy Expenditure in Subjects with Severe Obesity and Its Evolution After Bariatric Surgery

PurposeOne major determinant of weight loss is resting energy expenditure (REE). However, data regarding REE is scarce in patients with severe obesity (SO)—BMI>50kg/m2. Most studies used equation in order to estimate REE and not indirect calorimetry (IC) (gold standard). Additionally, there is no reliable data on the impact of bariatric surgery (BS) on REE.Objectives(a) To evaluate the REE in patients with SO; (b) to compare REE measured by IC (mREE) to that calculated by Mifflin St-Jeor equation (eREE); (c) to evaluate the impact of BS on REE and the relationship with evolution post-BS.Material and MethodsSingle-center observational study including consecutive patients with SO between January 2010 and December 2015, candidates for BS. mREE was determined at baseline, and 1 and 12 months post-BS by IC, using a Vmax metabolic monitor.ResultsThirty-nine patients were included: mean age 46.5±11.77 years, 64.1%women. Preoperative mREE was 2320.38±750.81 kcal/day. One month post-BS, the mREE significantly decreased (1537.6 ± 117.46 kcal/day, p = 0.023) and remained unchanged at 12 months (1526.00 ± 123.35 kcal/day; p =0.682). Reduction in mREE after the BS was a predictor of reaching successful weight loss (nadir) and weight regain (5 years follow-up) (AUCROC of 0.841 (95%CI [0.655–0.909], p=0.032) and AUCROC of 0.855 (95% CI [0.639–0.901]), p= 0.027, respectively). eREE was not valid to identify these changes.ConclusionIn patients with SO, a significant reduction of mREE occurs 1 month post-BS, unchanged at 12 months, representing the major conditioning of successful weight loss and maintenance post-BS.Graphical abstract

Chew and spit (CHSP) in bariatric patients: a case series

BackgroundStudies into the disordered eating behaviour of chew and spit have alluded to several cohorts more likely to engage in the behaviour, one such group being bariatric surgery candidates and patients. Weight-loss surgery candidates have received little to no attention regarding engaging in chew and spit behaviour. Changes in pre- and post- surgery eating pathology related to chew and spit behaviour has yet to be explored and described in academic literature.Case presentationThe current study reports on three cases of individual women, aged 30, 35, and 62 respectively, who indicated engagement in chew and spit. All three cases underwent bariatric surgery (two underwent gastric bypass, one underwent vertical sleeve gastrectomy). Eating pathology—including chew and spit behaviour, anxiety and depression, and adherence to the Norwegian nutritional guidelines were examined pre-operatively and post-operatively (one and two-year follow-up). At baseline (pre-surgery), two participants reported that they engaged in chew and spit, compared to one patient post-surgery. All three cases reported that they, to at least some extent, adhered to dietary guidelines post-surgery. Subjective bingeing frequency appeared to be relatively low for all three cases, further declining in frequency at one-year follow-up. At baseline, one participant reported clinically significant depression and anxiety, with no clinically significant depression or anxiety reported at follow-ups in participants that chew and spit.ConclusionsThe current study provides a starting point for the exploration of chew and spit as a pathological symptom of disordered eating in bariatric patients. It highlights the need to further explore chew and spit before and after weight-loss surgery.

Nutritional status prior to bariatric surgery for severe obesity: a review.

Obesity pandemic represents a threat to public health of paramount importance. Bariatric surgery represents the most effective and long-lasting treatment for severe obesity so far. The nutritional status of obese patients seeking bariatric surgery is impaired prior to surgery because of prevalent nutritional deficiencies. In addition, excess micronutrient levels may also occur, although this finding is not common. The onset of nutritional anomalies encountered in bariatric surgery candidates might stem from the following: obesity itself, poor quality food choices, preoperative weight loss or insufficient/excessive preoperative oral supplementation with vitamins and minerals. Nutritional management should begin preoperatively and should include a comprehensive assessment in order to identify those patients with clinical or subclinical deficiencies and hypervitaminoses. This paper provides background information on the nutritional status of bariatric surgery candidates, as well as on the prevalence and clinical significance of the most common micronutrient deficiencies and excess levels reported preoperatively among these patients.

The Relationship Between Psychiatric Problems and Eating Disorder Symptoms in Candidates for Bariatric Surgery

Objective: Obesity and overweight are global problems. They increase patient’s morbidity and mortality and may cause severe medical conditions affecting physical, mental, and or social health. Bariatric surgery is a durable solution for treating morbid obesity. This study aimed to determine the associations between psychiatric problems and eating disorder symptoms in candidates for bariatric surgery. Methods: In this cross-sectional study, 140 participants were selected from the patients who had already been referred to the obesity clinic in Firoozgar Hospital in Tehran, Iran, for bariatric surgery from April to June 2017. To collect study data, we used the eating disorder questionnaire for assessing eating disorders and the symptom checklist questionnaire for evaluating psychiatric problems. Results: The results of the Chi-squared test showed a significant association (P&lt;0.05) between eating disorder symptoms and psychiatric problems (phobia, anxiety, depression, obsessive-compulsive, psychoticism, hostility, paranoid ideation, and somatization). However, there was no significant correlation (P&gt;0.05) between eating disorder symptoms and interpersonal sensitivity. Conclusion: This study showed that eating disorders were significantly correlated with psychiatric problems.

The Prevalence of Metabolically Healthy and Unhealthy Obesity Among Bariatric Surgery Candidates, According to ATPIII Criteria

Background/Aim: Previous studies have demonstrated that patients with obesity can be metabolically healthy. However, little is known about the healthy or unhealthy metabolic status of patients undergoing bariatric surgery. This study, therefore, assesses the prevalence of metabolically healthy (MHO) and unhealthy (MUO) obesity among bariatric surgery candidates. Methods: The study involved 713 bariatric surgery candidates (580 women and 133 men; age range 18-69 years). MHO and MUO were defined according to The National Cholesterol Education Program-Adult Treatment Panel III (ATP III). Results: Mean (±SD) patient age, weight, body mass index (BMI), waist and hip circumference were 40.44 (±10.26) years, 127.15 (±22.15) kg, 164.33 (±8.85) cm, 46.90 (±5.79) kg/m2, 122.57 (±13.93) cm, and 140.10 ( ±12.40) cm, respectively. 318 patients (44.6%) were classified as MHO and 395 (55.4%) as MUO. A higher percentage of participants aged 40 years and older suffered from unhealthy metabolic status (61%). Conclusion: A large percentage of bariatric surgery candidates are metabolically healthy. Additionally, the prevalence of MHO was higher at younger ages

The Potential Role of Fish Oil/Omega-3 Polyunsaturated Fatty Acids Supplementation on Liver Size Before Bariatric Surgery

Background: An enlarged liver, which is resulted from fatty liver and/or steatohepatitis, makes difficulties in gastric bypass surgery procedure and increases the risk of liver laceration. omega-3 polyunsaturated fatty acids (ω-3 PUFAs) recently have been suggested as a potential intervention to reduce liver inflammation and volume. This review aimed to provide a comprehensive overview of the recent advances on fish oil/ ω-3 PUFAs supplementation to reduce the liver volume proceeding to bariatric surgery. Methods: This review summarizes studies that were investigated the influence of fish oil/omega-3 PUFA in the liver volume of bariatric surgery candidates. Scopus and PubMed databases were systematically searched up to May 2021, for studies providing knowledge relating to the effects of omega-3 and/or fish oil supplementation on liver size, fatty liver, or steatohepatitis. Results: Most of the randomized controlled trials showed that ω-3 PUFA supplementation, mostly due to its anti-inflammatory and antioxidative properties, is a practical and effective treatment for fatty liver, and to decrease ALT, AST, and GGT. Omega-3 fatty acids as important regulators of hepatic gene transcription can reduce hepatic steatosis and inflammation markers, also improve insulin sensitivity. As well, the access to the gastroesophageal junction was reported as simple. Conclusion: The collective data suggest that preoperative fish oil ω-3 PUFA supplementation could be an effective approach in improving liver function and decrease liver volume before bariatric surgery. Although, well-designed randomized clinical trials are needed to confirm these results and determine a clear protocol of supplementation regarding the optimal dose and duration before surgery.

Comparison of RAMP and New Modified RAMP Positioning in Laryngoscopic View During Intubation in Patients with Morbid Obesity: A Randomized Clinical Trial

BackgroundThe prevalence of obesity is increasing worldwide, and anesthesiologists are facing challenges in the airway management of such patients. Excessive adipose tissue influences pharyngeal spaces and affects the laryngoscopic grade. Standard ramp positioning is time-consuming and difficult to prepare, and requires expensive equipment.ObjectivesThe aim of this study was to compare the standard ramp position with the proposed low-cost and easily accessible modified ramp position in laryngoscopic view during the intubation of patients with morbid obesity.MethodsIn this single-blind clinical trial, 84 patients candidate for bariatric surgery at Rasoul Akram Hospital in 2020 were assigned to the rapid airway management positioner (RAMP) (R) and new modified RAMP (MR) groups by the block randomization method. The laryngoscopic view of the glottis based on the Cormack-Lehane scale, ventilation quality, duration of intubation, intubation attempts, oxygen saturation at the end of intubation, and the need for backward, upward, rightward pressure (BURP) maneuver for successful intubation were recorded. Normal distribution tests and Mann-Whitney and Kruskal-Wallis tests were used to analyze the data.ResultsThe results showed no significant differences between the two groups regarding ventilation score, laryngoscopy grade, number of intubation attempts, duration of intubation, and the need for BURP maneuvers during intubation (P > 0.05).ConclusionsThe two methods are not significantly different, and the new modified ramp position can be used with more ease and availability and less cost.

PERFORMACE OF TRIGLYCERIDE-GLUCOSE INDEX ON DIAGNOSIS AND STAGING OF NAFLD IN OBESE PATIENTS

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the world, and its prevalence is increasing alongside obesity. In United States, NAFLD is already the second leading cause of liver transplantation. The spectrum of the disease ranges from simple steatosis, which has a benign course, to steatohepatitis, which may progress to cirrhosis and its complications. The rising of noninvasive methods for diagnosing and staging non-alcoholic steatohepatitis (NASH) and fibrosis decreases the need of liver biopsy, as well as the costs and the occurrence of complications related to it. To analyze the performance of the triglyceride-glucose index to evaluate steatosis, NASH and liver fibrosis in obese patients with NAFLD. This is a retrospective cross-sectional study. Every medical record of patients who were candidates for bariatric surgery at a leading hospital in Southern Brazil were analyzed. The triglyceride-glucose index (TyG Index), a method composed only of two simple laboratory tests (serum triglycerides and fasting glucose levels), was performed prior to surgery. The TyG Index performance regarding the anatomopathological findings was evaluated, and the AUROC curve was calculated to evaluate the best cut-off point for diagnosing steatosis, non-alcoholic steatohepatitis and liver fibrosis grade. Also, the NAFLD fibrosis Score (NFS) was evaluated. A total of 423 patients were evaluated. The TyG Index with a cut-off point of 8.76 excluded significant simple steatosis (grade 2-3) in obese patients, with 67.6% sensitivity, 65.1% specificity, 46.3% positive predictive value (PPV), 81.8% negative predictive value (NPV), 65.8% accuracy and 0.66 AUROC (P=0.005). In the evaluation of NASH, the TyG Index with a cut-off point of 8.82 excluded significant NASH (grade 2-3) with 57.3% sensitivity, 58.6% specificity, 33.7% PPV, 78.8% NPV, 58.2% accuracy and 0.58 AUROC (P=0.022). When evaluating liver fibrosis, the TyG Index with a cut-off point of 8.91 showed a sensitivity of 61.8%, a specificity of 62.5%, a PPV of 13.8 and a NPV of 94.4% for exclusion of advanced fibrosis (F3-4), with a 62.4% accuracy and 0.69 AUROC (P<0.001). When analyzing the performance of NFS in the diagnosis of advanced fibrosis, the cut-off point <-1.455 excluded advanced fibrosis with sensitivity of 59.4%, specificity of 51%, PPV of 11%, NPV of 92.4% and accuracy of 51.7%. However, the cut-off point of 0.676 to diagnose advanced fibrosis presented sensitivity of 21.9%, specificity of 83%, PPV of 11.7%, NPV of 91.2% and 77.3% accuracy. The AUROC was 0.54 (P=0.480). TyG Index did not perform well in the diagnosis of significant steatosis and NASH. However, it was able to exclude advanced fibrosis in obese patients who are candidates for bariatric surgery.

Development and Validation of a Nomogram for Predicting Obstructive Sleep Apnea in Bariatric Surgery Candidates.

BackgroundObstructive sleep apnea (OSA) is highly prevalent in bariatric surgery patients and can lead to potential perioperative risks, but some screening tools lack adequate performance in this population. Thus, we aimed to develop and validate a clinical nomogram for predicting OSA in bariatric surgery candidates.MethodsWe retrospectively collected the data of 482 bariatric surgery patients between September 2015 and January 2020. Patients were randomly classified into training cohort (n=338) and validation cohort (n=144). The Lasso regression was used to select potentially relevant features; then, multivariable logistic regression analysis was used to establish the nomogram. Discrimination, calibration and clinical usefulness of the nomogram were assessed using the C-index, calibration curve and decision curve analysis (DCA).ResultsThe overall prevalence of OSA was 71.0% and higher in males (88.2%) compared to females (60.1%). Of these, 26.1% had mild OSA, 14.9% had moderate OSA, and 44.8% had severe OSA. The nomogram consisted of gender, habitual snoring, type 2 diabetes mellitus (T2DM), neck circumference, body mass index (BMI) and age. The nomogram provided favorable discrimination, with a C-indexes for the training and validation cohort of 0.856 (95% CI: 0.816–0.897) and 0.829 (95% CI: 0.76–0.895), respectively, and good calibration. The DCA displayed that the nomogram was clinically useful.ConclusionWe established a concise and practical nomogram that could facilitate the preoperative individualized prediction of OSA before bariatric surgery, which may help clinicians select bariatric surgery patients with high-risk OSA for polysomnography (PSG).

The predictive role of parathyroid hormone for non-alcoholic fatty liver disease based on invasive and non-invasive findings in candidates of bariatric surgery

Non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) and hepatic fibrosis are the most detrimental hepatic abnormalities associated with increased body weight with devastating clinical outcomes. Therefore, there is a substantial necessity for efficient management strategies, including significant weight reduction. Bariatric surgery has been used as a therapeutic approach in a selected obese patient with NAFLD/NASH and other cardiometabolic comorbidities. The study is focused on the predictive role of PTH with the indices of hepatic steatosis/NAFLD and NASH based on liver biopsy, elastography, and sonography in morbidly obese patients. Ninety patients with BMI between 35 and 40 kg/m2 with more than two comorbidities who referred to Imam Reza outpatient clinic from December 2016 to September 2017 were recruited and underwent initial assessments, including demographic profiles, psychological assessment, anthropometric measurements, hepatic biopsy, and basic laboratory tests. Liver stiffness was evaluated using two-dimensional shear wave elastography (2D-SWE) at least two weeks before liver biopsy. The histological analysis of the liver was performed using biopsy samples which obtained from left hepatic lobe during bariatric surgery under direct surgeon observation using a 16-gauge Tru-cut needle. The study was approved by the ethical committee (IR.MUMS.fm.REC.1396.312). The level of PTH was significantly high in patients with positive histology for hepatic fibrosis, steatosis, and NASH/NAFLD compared to patients with negative histology (p = 0.005, p = 0.009, and p = 0.013, respectively). Also, patients with liver fibrosis confirmed by elastography had significantly higher serum PTH concentration than patients without fibrosis (p = 0.011). PTH was also positively correlated with hepatic fibrosis, NASH, and steatosis (p = 0.007, p = 0.012, p = 0.023, respectively). High levels of PTH was significantly associated with histological indices of (hepatic fibrosis, steatosis, NAFLD and NASH) and elasticity indices. Therefore, it is imperative to assess for high levels of PTH in the morbidly obese population pre-and post-bariatric surgery. However, for a more robust and comprehensive assessment, a randomized controlled trial is needed. The study was conducted in accordance with the practice guidance in the diagnosis and management of NAFLD from the American association for the study of liver disease (AASLD) 2018. Evidence obtained from well-designed cohort or case-control analytic studies.

Adherence to the mediterranean diet and metabolic syndrome: Potential relationship in patients candidates for bariatric surgery

Adherence to the mediterranean diet and metabolic syndrome: Potential relationship in patients candidates for bariatric surgery

Early continuous glucose monitoring for predicting remission of type 2 diabetes 1 year after bariatric surgery

BackgroundBariatric surgery in obese subjects can result in remission of type 2 diabetes (T2D) at a distant time post-surgery. The aim of our observational prospective single-centre study was to examine glycaemic patterns in adult T2D candidates for bariatric surgery using a continuous glucose monitoring (CGM) sensor for 14 days after surgery to search for indicators predictive of T2D remission 1 year later. MethodsPatients underwent CGM preoperatively and for 14 days postoperatively. Thereafter, body weight and glycated haemoglobin (HbA1c) levels were monitored at 3, 6 and 12 months after surgery. ResultsA total of 31 patients (mean age 47±2 years) were analyzed. After surgery, mean interstitial glucose levels fell rapidly from 157±31mg/dL preoperatively to 109±35mg/dL postoperatively (P<0.001), reaching nadir levels from day 3 after surgery. Successful bariatric surgery (loss of excess weight ≥50%) was observed in 28 (90%) patients, and diabetes remission (HbA1c≤6% with no antidiabetic treatment) 1 year after surgery was noted in 21 (68%) patients. CGM for 14 days post-surgery allowed prediction of diabetes remission 1 year after surgery: time spent above range <14% and standard deviation (SD) of glucose levels <33mg/dL were both strong predictors of T2D remission. Indeed, the association of these two criteria predicted diabetes remission with a 100% positive predictive value, 81% sensitivity and 100% specificity and, when combined with the advanced Diabetes Remission (Ad-DiaRem) score, further increased predictive accuracy. ConclusionThe use of 14-day postoperative CGM recordings together with presurgical clinical scores can help to predict diabetes remission 1 year after bariatric surgery.

Neurocognitive and Psychopathological Predictors of Weight Loss After Bariatric Surgery: A 4-Year Follow-Up Study.

Twenty to thirty percent of patients experience weight regain at mid and long-term follow-up. Impaired cognitive functions are prevalent in people suffering from obesity and in those with binge eating disorder, thereby, affecting the weight-loss outcomes. The aim of our study was to investigate neurocognitive and psychopathological predictors of surgical efficacy in terms of percentage of excess weight loss (%EWL) at follow-up intervals of one year and 4-year. Psychosocial evaluation was completed in a sample of 78 bariatric surgery candidates and included psychometric instruments and a cognitive battery of neuropsychological tests. A schedule of 1-year and 4-year follow-ups was implemented. Wisconsin Sorting Card Test total correct responses, scores on the Raven’s Progressive Matrices Test, and age predicted %EWL at, both, early and long-term periods after surgery while the severity of pre-operative binge eating (BED) symptoms were associated with lower %EWL only four years after the operation. Due to the role of pre-operative BED in weight loss maintenance, the affected patients are at risk of suboptimal response requiring ongoing clinical monitoring, and psychological and pharmacological interventions when needed. As a result of our findings and in keeping with the latest guidelines we encourage neuropsychological assessment of bariatric surgery candidates. This data substantiated the rationale of providing rehabilitative interventions tailored to cognitive domains and time specific to the goal of supporting patients in their post-surgical course.

476 Sleep-Disordered Breathing is More Predictive than Obesity of Increased Left Ventricular Mass Index in Bariatric Surgery Patients

Abstract Introduction Obesity and obstructive sleep apnea (OSA) are associated with left ventricular hypertrophy and increased cardiovascular risk. Alternatively, the “obesity paradox” describes an improved prognosis from heart failure in obesity, though potentially attributable to confounding/bias. We sought to determine the contributions of obesity and sleep-disordered breathing (SDB) to left ventricular function and morphology in bariatric surgery candidates. Methods Patients undergoing polysomnography prior to bariatric surgery from 2011–2018 had demographic (age, gender, race), anthropometric (body mass index [BMI], neck circumference), comorbidities (atrial fibrillation, coronary artery disease, diabetes, hypertension, hyperlipidemia), echocardiographic and sleep-disordered breathing (apnea-hypopnea index [AHI], peak end-tidal CO2 [etCO2]) variables retrospectively examined. The echocardiographic visit closest to polysomnogram within two years was selected with missing values filled by available values within 6 months. Linear regression assessed the relationship of BMI, AHI, and etCO2 with left ventricular mass index (LVMI) after adjustment of demographics and comorbidities. Echocardiographic measures were logarithm transformed before regression analysis. Coefficients and 95% confidence intervals (CI) were calculated by exponential transformation. The analysis was performed based on an overall significance level of 0.05 using SAS software (version 9.4, Cary, NC). Results The total of 832 patients had 24% males, mean age 48.8±12, 60% white, and BMI:49.4±9.5kg/m2. Ejection fraction (%) was 60.0±7.0, and LVMI (g/m2): 80.9±23.7. In adjusted models, LVMI decreased by 2.1% for each 5kg/m2 increase in BMI (coefficient=0.979, 95%CI 0.961–0.997, p=0.022) and increased by 4.3% for each 5 mmHg increase in etCO2 (coefficient=1.043, 95%CI 1.013–1.073, p=0.005). Without adjustment, patients with AHI ≥ 5 had 15.3% higher LVMI than non-OSA group (coefficient=1.153, 95%CI 1.034–1.286, p=0.011) and moderate/severe OSA was associated with a 7.6% higher LVMI than those with AHI&amp;lt;15 (coefficient 1.076, 95%CI 1.003–1.153, p=0.040), but not statistically significant after adjustment. Conclusion In obese patients, nocturnal hypoventilation rather than obesity may have adverse influences on left ventricular morphology. Future studies should focus on clarifying whether obesity is truly protective in terms of LV mass, i.e. reflective of paradox versus a product of bias. The potential benefit of identifying/treating SDB in bariatric surgery candidates to mitigate cardiovascular risk also deserves further investigation. Support (if any) Cleveland Clinic Transformative Resource Neuroscience Award